Prevalence, risk factors and outcomes of peripartum hysterectomy at Kigali University Teaching Hospital: A retrospective study from 2017 to 2021

Abstract

Background: Peripartum hysterectomy is defined as the removal of the uterus during cesarean section (cesarean hysterectomy) or shortly after vaginal delivery (postpartum hysterectomy). Peripartum hysterectomy, a life-saving surgical procedure for women with complicated obstetric hemorrhage, is associated with high maternal morbidity and mortality especially in low and middle income countries. There is scarcity of data on the prevalence, risk factors, and outcomes of peripartum hysterectomy in Rwanda Study design: This study was designed as a retrospective cross-sectional study which evaluated the prevalence, risk factors and outcomes of 157 peripartum hysterectomies done among 30,134 women who presented at CHUK in the department of Obstetrics and gynecology for a five-year period from January 1, 2017 to December 31, 2021. Data were collected using a questionnaire and entered in epidata 3.1 then exported to Stata 13 for analysis. The results were presented using frequencies in tables and charts and the continuous data were presented using mean values and their standard deviations. The statistical significance for associations was taken at the level p < 0.05. Results: In our study, the rate of peripartum hysterectomy was found to be 5 in 1,000 deliveries; the median age for the participants was 33 years (range 16 to 48 years). Among risk factors of peripartum hysterectomy in our study, the most common was Cesarean delivery at 85.9%(135 of the participants) with history of previous C/S at 63.06%(99 of the participants); placenta previa/accrete followed at 29.3%(46 of the participants), uterine infection post C/S at 24%(39 of the participants), uterine atony at 17.83%(28 of the participants), uterine rupture at 16.56%(16 of the participants), placenta abruption at 6.37%(10 of the participants), and extending cervical tear/lacerations at 5.1%(8 of the participants). Among the patient who underwent peripartum hysterectomy in our study, 87.9% were transfused with a median number of 5 units of blood components (range 2 to 39 units), and 12.1% were admitted in ICU. The mortality rate was found to be 8.92% (14 of the participants). Sepsis and hemorrhagic shock were the two leading causes of death at a rate of 57.1% and 42.3% respectively.

Conclusion: In our settings, the rate of peripartum hysterectomy is 0.5% and it carries significant maternal morbidity and mortality. Cesarean section in current pregnancy and previous cesarean section history were independent strong risk factors. Abnormal placentation (placenta accreta and placenta previa) and uterine infection after c/section are the 2 leading causes of peripartum hysterectomy. Therefore, there is need for further enhancement of primary cesarean section prevention strategies and the promotion of safe cesarean section practice.